Ontario Stroke Report Card, 2017/18: CorHealthOntario.ca South East Local Health Integration Network

Exemplary performance1 Acceptable performance2 Poor performance3 Data not available or benchmark not available

LHIN Variance 7 Indicator Care Continuum Provincial High Performers Indicator4 FY 2017/18 Within LHIN5 No. Category Benchmark6 (2016/17) (Min–Max) Sub-region/Facility LHIN Public awareness and 1 Proportion of stroke/TIA patients who arrived at the ED by ambulance. 58.7% (62.0%) 57.8 - 59.3% 65.9% Western Champlain sub-region 1, 11 patient education Annual age- and sex-adjusted inpatient admission rate for stroke/TIA (per 1,000 2 Prevention of stroke 1.6 (1.5) 1.4 - 1.8 1.1 Oakville sub-region 7, 8, 6 population). 3§ Prevention of stroke Risk-adjusted stroke/TIA mortality rate at 30 days (per 100 patients). 12.2 (11.1) 9.5 - 28.1 - - 11 Proportion of ischemic stroke/TIA inpatients aged 65 and older with atrial 4 Prevention of stroke fibrillation who filled a prescription for anticoagulant therapy within 90 days of 71.0% (67.8%) 62.5 - 86.7% 85.6% East sub-region 5, 12 discharge from acute care. Thunder Bay Regional Health 5 Prevention of stroke Proportion of ischemic stroke inpatients who received carotid imaging. 83.3% (85.3%) 33.3 - 92.6% 93.0% 14, 3 Sciences Centre Median door-to-needle time among patients who received acute thrombolytic Kingston Health Sciences Centre 6 Acute stroke management 31.5 (42.0) 24.0 - 65.0 33.0 10 therapy (tPA) (minutes). Target8: 30 minutes – Kingston General Site Proportion of ischemic stroke patients who received acute thrombolytic therapy 7§ Acute stroke management 14.4% (15.1%) 9.8 - 21.8% 17.7% London Middlesex sub-region 11, 4 (tPA). Target8: >12% Proportion of stroke/TIA patients treated on a stroke unit9 at any time during their 8§ Acute stroke management 80.5% (76.7%) 74.8 - 88.8% 81.8% Quinte sub-region 3, 10 inpatient stay. Target8: >75% Proportion of ischemic stroke/TIA patients discharged from the ED and referred to Hamilton Health Sciences Corp 9 Prevention of stroke 79.1% (74.7%) 0.0 - 100.0% 95.1% None secondary prevention services. - Juravinski 10§ Acute stroke management Proportion of ALC days to total length of stay in acute care. 33.0 (32.1) 0.0 - 72.8% 8.2% Bluewater Health, Sarnia 3 Proportion of acute stroke (excluding TIA) patients discharged from acute care and 11§ Acute stroke management 30.2% (27.9%) 14.5 - 36.0% 47.8% Lambton sub-region 1 admitted to inpatient rehabilitation. Target8: >30% Proportion of acute stroke (excluding TIA) patients with mild disability (AlphaFIM > 12§ Stroke rehabilitation 75.9% (80.0%) 73.9 - 84.1% * * 14, 3 80) discharged home. Median number of days between stroke (excluding TIA) onset and admission to Quinte Health Care – Belleville 13§ Stroke rehabilitation 11.0 (11.0) 4.0 - 15.0 5.0 None stroke inpatient rehabilitation. General Site Median number of minutes per day of direct therapy received by inpatient stroke 14§ Stroke rehabilitation 74.9 (71.5) 72.4 - 80.0 107.6 West Park Healthcare Centre None rehabilitation patients. Target8: 180 minutes/day Proportion of inpatient stroke rehabilitation patients achieving RPG active length 15§ Stroke rehabilitation 50.7% (51.3%) 40.0 - 62.4% 86.6% Providence Healthcare 12 of stay target. 16 Stroke rehabilitation Median FIM efficiency for moderate stroke in inpatient rehabilitation. 1.0 (0.9) 0.8 - 1.6 1.6 Providence Healthcare 3, 12 Mean number of home and community care rehab visits provided to stroke patients South East Home and 17 Stroke rehabilitation 15.3 (12.9) - 13.1 10, 3 on discharge from inpatient acute care or inpatient rehabilitation in 2016/17–2017/18. Community Care Proportion of patients admitted to inpatient rehabilitation with severe stroke (RPG Grand River Hospital Corp- 18§ Stroke rehabilitation 35.7% (45.7%) 20.0 - 40.9% 56.2% None 1100 or 1110). Freeport Site Proportion of stroke/TIA patients discharged from acute care to LTC/CCC 19§ Reintegration 3.9% (6.4%) 1.0 - 6.5% 1.9% Guelph-Puslinch sub-region None (excluding patients originating from LTC/CCC). Age- and sex-adjusted readmission rate at 30 days for patients with stroke/TIA for 20§ Reintegration 6.6 (5.1) 5.2 - 11.0 - - 10 all diagnoses (per 100 patients). Target8: 10.0

*Benchmark has not been specified for this indicator. Hospital Service Accountability Agreement indicator, 2015/16 - Data not available § Contributes to QBP performance

1 Benchmark achieved or performance within 5% absolute/relative difference from the benchmark. 7 Sub-region/Facility: Highest performer among acute care institutions treating more than 100 stroke 2 Performance at or above the 50th percentile and greater than 5% absolute/relative difference from patients per year, rehabilitation facilities admitting more than 62 stroke patients per year, or sub- the benchmark. regions with at least 30 stroke patients per year. LHIN: Top two with exemplary performance. 3 Performance below the 50th percentile. 8 Targets based on international, national and provincial targets, please refer to full report for details. 4 Facility-based analysis (excluding indicators 1, 2, 4, 7, 8, 11 and 19) for patients aged 18–108. 9 The revised definition was developed with the consensus of Stroke Network regional Indicators are based on CIHI data. Low rates are desired for indicators 2, 3, 6, 10, 13, 19 and 20. directors (February 2014). There were 16 stroke units in 2013/14, 21 in 2014/15, 28 in 2015/16, 35 in 5 Excludes sub-regions or facilities with fewer than six patients. 2016/17, and 39 in 2017/18 6 Top benchmark achieved between 2015/16 and 2017/18. Benchmarks were calculated using the ABC methodology (Weissman et al. J Eval Clin Pract 1999; 5(3):269–81) on sub-region or facility data. Stroke Progress Report, 2017/18 compared to 2014/15-2016/17: CorHealthOntario.ca South East Local Health Integration Network

Progressing Well1 Progressing2 Not Progressing3 Data not available

5 LHIN FY 2017/18 Variance Within LHIN 6 Indicator Care Continuum Greatest Improvement Indicator4 (Previous 3–Year 2017/18 (2014/15) No. Category Average) Min Max Sub–region/Facility LHIN Public awareness and District of Thunder Bay sub- 1 Proportion of stroke/TIA patients who arrived at the ED by ambulance. 58.7% (61.0%) 57.8% (57.3%) 59.3% (63.6%) 5,11 patient education region Annual age– and sex–adjusted inpatient admission rate for stroke/TIA (per 1,000 2 Prevention of stroke 1.6 (1.5) 1.4 (1.4) 1.8 (1.7) Cochrane sub-region 4 population). 3§ Prevention of stroke Risk–adjusted7 stroke/TIA mortality rate at 30 days (per 100 patients). 12.0 (12.8) 8.8 (0.0) 22.5 (36.8) - 12 Proportion of ischemic stroke/TIA inpatients aged 65 and older with atrial 4 Prevention of stroke fibrillation who filled a prescription for anticoagulant therapy within 90 days of 71.0% (67.7%) 62.5% (57.1%) 86.7% (100.0%) Elgin sub-region 7, 5 discharge from acute care. 5 Prevention of stroke Proportion of ischemic stroke inpatients who received carotid imaging. 83.3% (80.6%) 33.3% (11.1%) 92.6% (85.6%) Georgian Bay General 14 ,9 Median door–to–needle time among patients who received acute thrombolytic Windsor Regional Hospital 6 Acute stroke management 31.5 (51.0) 24.0 (42.0) 65.0 (60.0) 10, 9 therapy (tPA) (minutes). Target8: 30 minutes -Ouellette Proportion of ischemic stroke patients who received acute thrombolytic therapy Chatham City Centre sub- 7§ Acute stroke management 14.4% (13.7%) 9.8% (7.6%) 21.8% (19.6%) 1, 13 (tPA). Target8: >12% region Proportion of stroke/TIA patients treated on a stroke unit9 at any time during their 8§ Acute stroke management 80.5% (72.4%) 74.8% (53.3%) 88.8% (78.5%) Windsor sub-region 2, 14 inpatient stay. Target8: >75% Proportion of ischemic stroke/TIA patients discharged from the ED and referred to North Bay Regional Health 9 Prevention of stroke 79.1% (70.8%) 0.0% (4.2%) 100.0% (94.2%) 14, 10 secondary prevention services. Centre Windsor Regional Hosp- 10§ Acute stroke management Proportion of ALC days to total length of stay in acute care. 33.0% (26.0%) 0.0% (0.0%) 72.8% (42.6%) 1 Ouellette Proportion of acute stroke (excluding TIA) patients discharged from acute care Essex South Shore sub- 11§ Acute stroke management 30.2% (28.2%) 14.5% (19.4%) 36.0% (36.0%) None and admitted to inpatient rehabilitation. Target8: >30% region Proportion of acute stroke (excluding TIA) patients with mild disability (AlphaFIM 12§ Stroke rehabilitation 75.9% (77.7%) 73.9% (63.6%) 84.1% (83.3%) St. Joseph's Hamilton 9, 11 > 80) discharged home. Median number of days between stroke (excluding TIA) onset and admission to 13§ Stroke rehabilitation 11.0 (9.0) 4.0 (5.0) 15.0 (13.0) Bruyere Continuing Care 11, 14 stroke inpatient rehabilitation. Median number of minutes per day of direct therapy received by inpatient stroke 14§ Stroke rehabilitation 74.9 (-) 72.4 (60.7) 80.0 (84.4) - - rehabilitation patients. Target8: 180 minutes/day Proportion of inpatient stroke rehabilitation patients achieving RPG active length 15§ Stroke rehabilitation 50.7% (47.2%) 40.0% (45.6%) 62.4% (48.1%) St. Joseph of Hotel Dieu 12, 5 of stay target. Brant Community Healthcare 5, 7, 13, 16 Stroke rehabilitation Median FIM efficiency for moderate stroke in inpatient rehabilitation. 1.0 (0.8) 0.8 (0.7) 1.6 (0.9) System 4* Mean number of home and community care rehab visits provided to stroke patients on Waterloo Wellington Home 17 Stroke rehabilitation 15.3 (13.4) - - 11, 5 discharge from inpatient acute care or inpatient rehabilitation in 2016/17–2017/18. and Community Care Proportion of patients admitted to inpatient rehabilitation with severe stroke (RPG Southlake Regional Health 18§ Stroke rehabilitation 35.7% (44.5%) 20.0% (18.5%) 40.9% (53.5%) 11, 8 1100 or 1110). Centre Proportion of stroke/TIA patients discharged from acute care to LTC/CCC District of Rainy River sub- 19§ Reintegration 3.9% (5.9%) 1.0% (3.0%) 6.5% (7.7%) 10 (excluding patients originating from LTC/CCC). region Age– and sex–adjusted7 readmission rate at 30 days for patients with stroke/TIA 20§ Reintegration 6.5 (6.2) 5.1 (0.0) 10.5 (13.4) - None for all diagnoses (per 100 patients). Target8: 10.0

Hospital Service Accountability Agreement indicator, 2015/16 - Data not available § Contributes to QBP performance

1 Statistically significant improvement. 7 The 2014/15-2017/18 LHIN rate is used in calculating the LHIN risk-adjusted rate. 2 Performance improving but not statistically significant. 8 Targets based on international, national and provincial targets, please refer to full report for details. 3 No change or performance decline. 9 The revised definition was developed with the consensus of Ontario Stroke Network regional directors 4 Facility-based analysis (excluding indicators 1, 2, 4, 7, 8, 11 and 19) for patients aged 18–108. Indicators are (February 2014). There were 16 stroke units in 2013/14, 21 in 2014/15, 28 in 2015/16, and 35 in 2016/17, and based on CIHI data. Low rates are desired for indicators 2, 3, 6, 10, 13, 19 and 20. 39 in 2017/18 5 Excludes sub-regions or facilities with fewer than six patients. 6 Sub-region/Facility: Greatest improvement from 2014/15 among acute care institutions treating more than 100 stroke patients per year, rehabilitation facilities admitting more than 62 stroke patients per year, or sub-regions with at least 30 stroke patients per year. LHIN: Top two with greatest statistically significant improvement from 2014/15. Ontario Stroke Report Card, 2017/18 Local Health Integration Networks (LHINs) 1. Erie St. Clair 5. Central West 10. South East 2. South West 6. Mississauga Halton 11. Champlain 3. Waterloo Wellington 7. Central 12. North Simcoe Muskoka 4. Hamilton Niagara 8. Central 13. North East Haldimand Brant 9. Central East 14. North West Progressing Well1 Progressing2 Not Progressing3 Limited Data

Ontario Variance 6 Indicator Care Continuum Provincial High Performers Indicator4 FY 2017/18 Across LHINs No. Category Benchmark5 (2016/17) (Min–Max) Sub-region/Facility LHIN Public awareness and patient 1 Proportion of stroke/TIA patients who arrived at the ED by ambulance. 60% (59.2%) 54.9% - 64.2% 65.9% Western Champlain sub-region 1, 11 education Annual age- and sex-adjusted inpatient admission rate for stroke/TIA (per 1,000 2 Prevention of stroke 1.3 (1.3) 1.1 -1.9 1.1 Oakville sub-region 7, 8, 6 population). 3§ Prevention of stroke Risk-adjusted stroke/TIA mortality rate at 30 days (per 100 patients). 10.5 (10.7) 9.9 -17.1 - - 11 Proportion of ischemic stroke/TIA inpatients aged 65 and older with atrial 4 Prevention of stroke fibrillation who filled a prescription for anticoagulant therapy within 90 days of 74.2% (72.0%) 64% - 82.1% 85.6% East Mississauga sub-region 5, 12 discharge from acute care. Thunder Bay Regional Health 5 Prevention of stroke Proportion of ischemic stroke inpatients who received carotid imaging. 84.4% (82.7%) 81.7% - 92.4% 93.0% 14, 3 Sciences Centre Median door-to-needle time among patients who received acute thrombolytic Kingston Health Sciences Centre 6 Acute stroke management 45.0 (47.0) 31.5 - 327.0 33.0 10 therapy (tPA) (minutes). Target7: 30 minutes – Kingston General Site Proportion of ischemic stroke patients who received acute thrombolytic therapy 7§ Acute stroke management 12.2% (12.5%) 8.1% - 15.6% 17.7% London Middlesex sub-region 11, 4 (tPA). Target7: >12% Proportion of stroke/TIA patients treated on a stroke unit8 at any time during 8§ Acute stroke management 52.8% (45.6%) 16.0% - 80.6% 81.8% Quinte sub-region 3, 10 their inpatient stay. Target7: >75% Proportion of ischemic stroke/TIA patients discharged from the ED and referred Hamilton Health Sciences Corp 9 Prevention of stroke 78.8% (77.3%) 57.1% - 88.0% 95.1% None to secondary prevention services. - Juravinski 10§ Acute stroke management Proportion of ALC days to total length of stay in acute care. 31.1% (30.7%) 12.6% - 43.5% 8.2% Bluewater Health, Sarnia 3 Proportion of acute stroke (excluding TIA) patients discharged from acute care 11§ Acute stroke management 33.0% (34.8%) 23.9% - 44.8% 47.8% Lambton sub-region 1 and admitted to inpatient rehabilitation. Target7: >30% Proportion of acute stroke (excluding TIA) patients with mild disability (AlphaFIM 12§ Stroke rehabilitation 74.2% (72.6%) 55.2% - 93.0% * * 14, 3 > 80) discharged home. Median number of days between stroke (excluding TIA) onset and admission to Quinte Health Care – Belleville 13§ Stroke rehabilitation 8.0 (9.0) 6.0 -14.0 5.0 None stroke inpatient rehabilitation. General Site Median number of minutes per day of direct therapy received by inpatient 14§ Stroke rehabilitation 66.7 (64.8) 21.2 -92.8 107.6 West Park Healthcare Centre None stroke rehabilitation patients. Target7: 180 minutes/day Proportion of inpatient stroke rehabilitation patients achieving RPG active length 15§ Stroke rehabilitation 67.3% (65.8%) 46.2% -89.1% 86.6% Providence Healthcare 12 of stay target. 16 Stroke rehabilitation Median FIM efficiency for moderate stroke in inpatient rehabilitation. 1.1 (1.1) 0.9 -1.7 1.6 Providence Healthcare 3, 12 Mean number of home and community care rehab visits provided to stroke patients South East Home and 17 Stroke rehabilitation 8.4 (8.2) 5.0 -15.3 13.1 10, 3 on discharge from inpatient acute care or inpatient rehabilitation in 2016/17–2017/18. Community Care Proportion of patients admitted to inpatient rehabilitation with severe stroke Grand River Hospital Corp- 18§ Stroke rehabilitation 38.7% (42.3%) 27.9% - 50.0% 56.2% None (RPG 1100 or 1110). Freeport Site Proportion of stroke/TIA patients discharged from acute care to LTC/CCC 19§ Reintegration 7.0% (6.7%) 2.6% -12.8% 1.9% Guelph-Puslinch sub-region None (excluding patients originating from LTC/CCC). Age- and sex-adjusted readmission rate at 30 days for patients with stroke/TIA 20§ Reintegration 7.8 (7.6) 6.6 -9.7 - - 10 for all diagnoses (per 100 patients). Target7: 10.0

*Benchmark has not been specified for this indicator. Hospital Service Accountability Agreement indicator, 2015/16 - Data not available § Contributes to QBP performance

1 Statistically significant improvement. 7 Targets based on international, national and provincial targets, please refer to full report for details. 2 Performance improving but not statistically significant. 8 The revised definition was developed with the consensus of Ontario Stroke Network regional 3 No change or performance decline. directors (February 2014). There were 16 stroke units in 2013/14, 21 in 2014/15, 28 in 2015/16, 35 in 4 Facility-based analysis (excluding indicators 1, 2, 4, 7, 8, 11 and 19) for patients aged 18 -108. 2016/17 and 39 in 2017/18. Indicators are based on CIHI data. Low rates are desired for indicators 2, 3, 6, 10, 13, 19 and 20. 5 Top benchmark achieved between 2015/16 and 2017/18. Benchmarks were calculated using the ABC methodology (Weissman et al. J Eval Clin Pract 1999; 5(3):269 -81) on sub-Region or facility data. 6 Sub-region/Facility: Highest performer among acute care institutions treating more than 100 stroke patients per year, rehabilitation facilities admitting more than 62 stroke patients per year, or sub -regions with at least 30 stroke patients per year. LHIN: Top two with exemplary performance.